At face value Type 2 Diabetes (DM2) seems to be a permanent progressive condition with little chance of improvement. Most people with the disorder progress through stages of progressive insulin resistance and rising blood sugar which require ever greater levels of medication over time. Millions of people have DM2 and you don’t usually hear of it getting better.
I first had some fleeting doubts about this understanding during my residency training. One day I learned that under some circumstances DM2 can be eliminated swiftly through bariatric surgery. A miracle, I thought. How can that be? And if that is true, as it is, shouldn’t there be some other way to accomplish this short of major surgery?
It made intuitive sense that high carbohydrate diets were at the core of DM2. I did a great deal of reading of the medical literature and even at that time there were a few small trials that looked at insulin resistance in ketogenic diets and other low-carb paradigms that showed promise.
But I never had too much success implementing these practices in clinic myself. And then you know how things go. All of a sudden it was 10 years later.
This is where my story of fasting began.
One day in clinic I had a patient with DM2 come in who was scheduled for colonoscopy and needed management of their insulin. This is routine in medical practice but on this occasion the patient was on very high doses of insulin. I had not approached this scenario with such high doses before and wondered what the right answer was.
Our rule of thumb is to cut basal insulin levels in half when people are fasting for a procedure. We also cut out short acting doses when meals are absent. This practice works well but it felt like it would not be sufficient in this case. Hypoglycemia is a big risk and so erring on the side of caution I lowered the insulin by 4/5ths.
Much to my surprise this patients blood sugar still dropped too low during the procedure. The insulin was still too high.
All at once I had a rush of thoughts. My speculation from residency returned. But also the experiences I have had interacting with so many patients over the years who practice fasting. I have many Muslim, Hindu, Jewish, and even some Christian patients who fast.
I started thinking about all the times people fast in medicine. We just don’t always call it fasting. People are NPO for one reason or another.
Or they are fasting for labs or they are just plain sick. People are going for periods of time without eating all the time. Often from a very compromised state.
At that point I did not really know what to do. I didn’t feel like I could talk to patients about fasting. It’s not anything I had been instructed about. It’s not a common practice in our culture and seems contrary to many conventional dietary recommendations. It also seemed like something I would never want to do myself. I felt like I couldn’t ask people to do something I was leery of.
That said, I wasn’t sold on traditional dietary recommendations either. After thinking for a few weeks and doing as much reading about fasting as I could I convinced myself that the potential was great and I needed to try it myself. If I couldn’t do it I would definitely not be talking to patients about it. See that story (HERE).
Lets Get Real
After practicing various forms of fasting for about two months and coming to feel very much better myself I decided, yes, I can try cautiously discussing this with people.
I was thinking “Who would ever want to fast?” Well it turns out many patients on insulin, upon hearing that there is a chance it could get them off insulin, don’t find it to be a hard sell. (Full disclosure: it is a very hard sell for some). But I was surprised how many people started taking me up on it and were excited about it.
Be Advised:
Do not start fasting and self-titrating insulin and other diabetic meds. You need a relationship with a primary care provider who feels comfortable helping you managing this. Hypoglycemia is a risk and requires diligent monitoring, medication titration and close clinical contact.
Many insulin using patients are interested in trying a level 1 fasting program. Of those that try a fair number see fairly prompt ability to safely lower insulin within 3 weeks. Some take a good deal longer, many months. Some patients are either not able to comply with this practice at that time despite their best efforts or do not always see as strong an effect as hoped for. If patients try and can’t do it they can continue standard care, no problem. But it leaves open the potential of a better path.
As the number of patients who were getting off insulin grew over the coming months I realized this doesn’t need to be limited to insulin. Turns out anyone with DM2 could have potential benefit. So the number of patients I was talking about fasting with started growing exponentially. And the good news kept coming. I was able to stop many oral medications. A1c levels were improving across the board.
Then the secondary effects start to become evident. People’s cholesterol gets better. Blood pressure goes down. Patients are able to lose weight without exercising. People’s GI tract feels better and they ask to stop PPIs. Patients report more energy. Many report sleeping better. Some ask to stop taking antidepressants.
So if you have DM2 I have some good news for you. If you are up for a personal challenge you may be able to try fasting and see if your blood sugar management can improve. Talk to your doctor and review your personal medical situation so you have them on board to help you.
Need more help? Join our online fasting community! If you’re in Wisconsin, call Dr. Z for a personal consultation!
Why Does Fasting Help DM2?
All food we eat stimulates insulin, carbohydrates the most. When we are eating throughout the day insulin is always being produced. As this insulin keeps stimulating and over-stimulating insulin receptors it stands to reason that the receptors get chronically down-regulated. This is likely at least one key factor in how insulin resistance develops.
All of a sudden you fast. Instead of burning new food for energy you burn the blood sugar. That is food you previously ate that the body has not been able to handle properly. When glucose levels return to normal you switch to body-fat. There is no more need for insulin. Insulin levels can drop. Now there is no drive for insulin resistance. We have not appreciated the dynamic nature of this system. Insulin sensitivity can return.
Fasting is like a giant reset button on insulin sensitivity. It appears to be a reset button on many other things as well.